ALUMNI VENTURE FUND APPLICATION 2021-2022

Alumni Venture Fund Project

A program of the U.S. Department of State and implemented by IREX

Application Deadline: December 30, 2021.

Title of your proposed Alumni Venture Fund Project/Project Team Name:*

Alumni Venture Fund team: A MEPI Alum (“Team Leader”) must submit a complete application with at least one collaborator (“Team Member 1”); Team Member 1 may be a MEPI or other Department Of State alum. Additional team members are encouraged but not required.

TEAM LEADER INFORMATION

Name : (First and last name as it appears in your passport in English): *

First Name

Last Name

Citizenship*

Place of Current Residence*

Permanent Home/Mailing Address (Street, City, Postal code, Country):*

Email*

Age*

Phone*

Please upload a scan of your passport bio-data page* No File Chosen

File uploads may not work on some mobile devices.

Current Institution (University or Employer):

Institution Name:*

Current Position:*

Institution Address (Street, City, Postal Index, Country):*

Name and Year of 1st MEPI program participation:*

Are you now or have you been in the last year employed by a U.S. mission abroad working for the U.S. Department of State?*

Yes No

Are you or one of your immediate family members (spouse, parent, child, sibling) a current employee or consultant for IREX?*

Yes No

TEAM MEMBER 1 INFORMATION

Name : (First and last name as it appears in your passport in English): *

First Name

Last Name

Citizenship:*

Place of Current Residence:*

Permanent Home/Mailing Address: (Street, City, Postal code, Country):*

Email*

Phone*

Current Institution (University or Employer):

Institution Name:*

Current Position:*

Institution Address (Street, City, Postal Index, Country):*

Name and Year of MEPI or DOS program participation:*

Are you now or have you been in the last year employed by a U.S. mission abroad working for the U.S. Department of State?*

Yes No

Are you or one of your immediate family members (spouse, parent, child, sibling) a current employee or consultant for IREX?*

Yes No

GRANTS INFORMATION

Title of your proposed Alumni Venture Fund Project:*

In which of the eligible countries are you proposing to implement your project?*

Alumni Venture Fund Category:*

Community Service Project - voluntary work for the betterment of one’s community or country Private Enterprise Project - a small business or entrepreneurial project privately managed by an individual or an external company Social Enterprise Project - a small business or entrepreneurial project that has a goal of contributing to the welfare of others (socially, financially, or environmentally) while also making a profit

Total Grant Value Requested in USD (Grant Value: minimum of $5000 - maximum $10000):*

PROJECT INFORMATION

Project Focus (the “what”): Please summarize your project (100 words or less).*

Problem Statement (the “why”): What specific local needs will your project address? Please list at least two. Please provide background information identifying what the problem is, including examples, research or other evidence as available. If applicable, please describe how you conducted an assessment to determine these needs. (200 words or less)*

Why is this problem important to solve? Please describe at least three sustainable (long-term) benefits that the project will have in the community after all activities have concluded (e.g. in the case of a training, will participants/beneficiaries plan to share their new knowledge with others?) (200 words or less)*

Who are the direct beneficiaries of your project? How many people would benefit from your project overall? What kind of skills, knowledge, or new information will your project bring to those that participate in/benefit from your project? (100 words or less)*

Project Approach (the “how”): What steps will you need to take to implement the project? (e.g. Will you need to receive permission from someone in the community to implement your project? Who? If you are giving a training or workshop, where will it take place? How will you promote your project?) (200 words or less)*

What are the roles and responsibilities of the Team Lead and Team Member 1? (100 words or less)*

How many other collaborators or volunteers, both Alumni and/or non-Alumni, do you expect to participate in your project, in addition to the project team members listed and identified above? How will you recruit them? Please list their names, countries, DOS program, and DOS program year, if already known. (200 words or less)*

Will you partner with one or more institutions to implement the project such as a school, local NGO, governmental agency, university, and/or start-up? If yes, please briefly describe the institution(s) and how you will gain or have gained their support for your project. (200 words or less)*

What will success look like? What result(s) do you intend to achieve through this project? At the end of a successful project, what will you have to show?Please include a list of each project goal and number them (1, 2, 3, etc.). (200 words or less)*

How will the team assess the success of the project? How you will measure that success? What method(s) of monitoring and evaluation will you use? (Examples may include: surveys, focus groups, outside evaluator, etc.) (200 words or less)*

BRANDING INFORMATION FOR APPLICANTS

All materials produced under an Alumni Venture Fund small grant, including training materials, materials for recipients or materials to communicate or promote with foreign audiences a program, event, project, or some other activity under this agreement, must be marked appropriately with the standard U.S. flag in a size and prominence equal to (or greater than) any other logo or identity, AND with the standard MEPI logo (to be provided for use).

The following are potential exceptions:

Where a clear identification with the U.S. government or the U.S. flag would create a demonstrable security threat to the U.S. government, its personnel, partners, the program participants or beneficiaries, or the program or venue of the activity.

Where a clear identification with the U.S. government or the U.S. flag would undermine the objectives of the activity.

Will you be able to comply with the branding requirements for your project if it were to be funded under the Alumni Venture Fund?*

If not, what would be the reason(s) for requesting a waiver?*

PROJECT BUDGET

Please download the budget & workplan template here, fill it with as many details as possible, and upload it in the section below.

Please use the template to indicate how you plan on spending the grant funds: Please be as specific as possible regarding your expenses to demonstrate the accuracy of your budget. Please include any anticipated fees that your bank may charge in order to disburse the project funds. Be sure to review allowable and unallowable costs as outlined on page 4 of the application instructions. Please add additional rows to the spreadsheet as needed. IREX anticipates making these awards as a lump sum fixed award. However, if awardees do not complete the project, IREX may require you to return payments. See also Liabilities (p. 8-9) which outlines measures IREX will take if the proposed budget is not constructed in good faith.

*Cost Share Contribution (NOT required): “Cost Share” means non-U.S. government funds or donated resources that will be used for the project. Wherever possible, please include any information regarding cost share for project needs. Cost-share can include donated meeting space in a school building or other organization; donated materials or equipment (such as laptops), food, etc. If applicable, please include the approximate cost of the items that are donated or shared.

Upload your Budget and Work Plan* No File Chosen

File uploads may not work on some mobile devices.

In what local currency are you calculating the budget below and spending the grant funds?*

What is the exchange rate you are using to calculate US dollar (USD):*

From what resource did you determine this rate? (i.e. National Bank, xe.com, oanda.com, etc.)*

On what day did you retrieve this exchange rate?*

Activity Risk Assessment and Mitigation Plan:

Please copy and answer the following questions into a Word Document and upload it using the following tab:

Prepared by (name):

Date:

Risk Assessment

Please describe the Covid-19 protocols and descriptions for the community and country of the activity:
Please describe the social and political situation for the community and country of the activity (restriction or dangers in travel or gatherings, nearby unrest, attitudes towards activities, etc.):
Please describe any authorizations or approvals that your event may require prior to implementation:
Please description the event (type of activity, location, dates):
What are the expected number of persons (participants, guests, staff, consultants, etc.). How many attendees are travelling for this event and from where? (international, regional, etc.)

Mitigation Plan

Please describe what precautions will be taken by the team to prevent the spread of Covid-19 during the event and how those precautions will be enforced (social distancing, protective equipment, cleaning procedures):
Please describe what precautions will be taken by the team to ensure safety of participants in travelling, participating, and sharing any information about them or the event in the media or online:
Please describe any other planned precautions that will be taken by the team to ensure the safety and wellness of participants to mitigate any other identified risks in the community and country of the activity:
How will you handle unanticipated challenges that prevent you from following your original plan?
Please explain how will you decide with your teammates and stakeholders on alternative plans or approaches?
What is your pivot plan in case you are unable to implement according to your original plan? (Such as Covid-19 lockdowns, social unrest, unable to acquire necessary government authorizations, etc.) How might this impact your future project?

Please upload your Activity Risk Assessment and Mitigation Plan based on the Questions in the above box * No File Chosen

File uploads may not work on some mobile devices.

IREX Privacy Policy and Statement and Application Certification

Your privacy is important to IREX. That is why we request that all applicants read the following privacy policy statement carefully.

IREX Privacy Policy

Information about MEPI Alumni consists of data contained in their applications, information derived from interviews and reports, and information gathered during the course of their program and as program alumni. IREX stores this information in written and electronic form indefinitely. Some data, such as contact information and professional experience, is continually updated.

Information, which is described above, may be:

1)Used by selection committees and interviewers to review applicants;
2)Supplied to the U.S. Department of State;
3)Submitted to organizations that provide program-related opportunities;
4)Used for the evaluation of an individual’s participation in the program and in the collection of data for general program evaluation by IREX, U.S. Department of State or other organizations contracted to conduct evaluations;
5)Used for notifying program participants/alumni of upcoming events and programs;
6)Provided to participants/alumni of this and other U.S. government–sponsored programs for the purpose of fostering alumni networking;
7)Provided to non-commercial, nongovernmental organizations for the purposes of promoting professional development among program participants/alumni;
8)Used by IREX or the U.S. Department of State for general promotional purposes in written or electronic form, including program directories, newsletters, websites and other promotional materials;
9)Used by IREX or the U.S. Department of State to vet participants as required by law; and
10)Provided to authorities as required by law.

Photographs, Videos, and Images

I grant to IREX and its employees and the U.S. Department of State the right to take and/or use photographs and/or video of me and Alumni Venture Fund participants or material that I submit in connection with the program. I authorize copyright, use and publishing of these photographs and/or videos in print and/or electronically with or without my name for any lawful purpose, including for example such purposes as publicity, program materials and reports, and Web content. I will obtain the necessary permission from the subjects in the photographs/videos I submit and will consult with local institutions (if applicable) regarding appropriate release policy for photos/videos taken at the institution.

If you do not want to be included in any of points 5-8 and/or images, please notify IREX at mepialumni@irex.org upon submission of your application. IREX does not sell or trade applicant, or current/past grantee information.

Program Acknowledgement

Funding for the MEPI Alumni Connection must be secured each year by the U.S. government. US government

and IREX request that grantees assist us in this effort by providing proper acknowledgment of their successful participation in the MEPI Alumni Connection and the Alumni Venture Fund. In citing their Alumni Venture Fund project on resumes or CVs, at conferences, professional meetings, interviews or other public events, and in any related publications.Please use the following sample format:

"The MEPI Alumni Connection is a program of the U.S Department of state, US-Middle East Partnership Initiative (MEPI) and implemented by IREX".

The grantee agrees to supply IREX with copies of all training materials, publications or products resulting from this award upon request.

Liability: IREX and US government assume no responsibility for any injury, accident, illness, loss of personal property, or other contingencies that may befall a grantee during, or as a result of, participation in the Alumni Venture Fund.

Grantees may not charge the award security costs unless specifically approved in writing by IREX.
Special Provision for Performance in a Designated Combat Area (SPOT) applies to work in Iraq.

US government or IREX will not be liable for any claim or claims resulting from a grantee’s failure to enter upon or to complete the approved and awarded project outlined in the grantee’s Alumni Venture Fund proposal, even though the failure is beyond the grantee’s control, including without limitation any failure resulting from a revocation, or termination of the project.

By signing this agreement, the grantee acknowledges and agrees that:

(a)The budget provided in the application is a best estimate of actual costs. Any intentional inflation of costs may result in a termination of the award and requirement that the applicant return all payments received.

(b)In the course of his/her project implementation, the grantee may be exposed to a variety of risks and dangers including, without limitation, accidents, disease, infection, and threats to personal safety, and that these risks could result in injury, illness, temporary or permanent disability, loss of liberty, property or financial loss, psychological trauma or death. The grantee agrees that s/he: (i) engages in the Alumni Venture Fund voluntarily, and with full understanding of the risks and dangers; (ii) takes complete personal responsibility for his/her safety, security and health; and (iii) freely assumes all risk of harm to or loss of health, life, liberty, or property. The grantee further agrees that any actions taken by IREX to provide security or assistance to the grantee during an approved and awarded Alumni Venture Fund project are in no way to be taken as an assumption of responsibility by IREX for the wellbeing and security of the grantee.

(c)IREX and US government shall be released, indemnified, and held harmless by the grantee from any and all costs, claims, losses, damages or liability whatsoever arising from the acts or omissions of any third party during or in connection with the grantee’s approved and awarded Alumni Venture Fund project, or any injury, illness, physical or mental trauma, property or financial loss, loss of liberty or disability the grantee may suffer in connection with participation in the Alumni Venture Fund project.

(d)The grantee will adhere to all local laws and regulations in the country of activity during the implementation of an approved and awarded Alumni Venture Fund project.

(e)The grantee will not conduct any medical or health-related procedures on human subjects during the course of an approved and awarded Alumni Venture Fund project.

This Agreement will be governed by and construed in accordance with the laws of the District of Columbia, United States of America, without regard to its conflicts of law’s provisions.

The principles stated herein are binding only to IREX; other organizations involved in the administration of grants may adhere to other privacy or similar policies.

Consent

I certify that I completed this application, without assistance, that the information given in this application is complete and accurate and that I have carefully read and understood and all notes and disclaimers provided therein.

I understand that IREX reserves the right to verify all the information listed in the application. I understand that giving false or misleading information in the application will result in exclusion from the competition or immediate dismissal from the Alumni Venture Fund.

Signature of Team Lead

Signature*

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Date/Time*